Are concerns over right laparoscopic donor nephrectomy unwarranted?

Objective To examine the ability of several large, experienced transplantat ion centers to perform right-sided laparoscopic donor nephrectomy safely wi th equivalent long-term renal allograft function. Summary Background Data Early reports noted a higher incidence of renal vei n thrombosis and eventual graft loss. However, exclusion of right-sided don ors would deprive a significant proportion of donors a laparoscopically har vested graft. Methods A retrospective review was performed among 97 patients from seven c enters performing right-sided laparoscopic donor nephrectomy. Surgical and postoperative demographic factors were evaluated. Complications were identi fied and longterm renal allograft function was compared with historical lef t-sided laparoscopic donor nephrectomy cohorts. Results Right laparoscopic donor nephrectomy was performed for varying reas ons, including multiple left renal arteries or veins,smaller right kidney, or cystic right renal mass. Mean surgical time was 235.0 +/- 66.7 minutes, with a mean blood loss of 139 +/- 165.8 mL. Conversion was required in thre e patients secondary to bleeding or anatomical anomalies. Mean warm ischemi c time was limited at 238 +/- 112 seconds. Return to diet was achieved on a verage after 7.5 +/- 2.3 hours, with mean discharge at 54.6 +/- 22.8 hours. Two grafts were lost during the early experience of these centers to renal Vein thrombosis. Both surgical and postoperative complications were limite d, with few long-term adverse effects. Mean serum creatinine levels were hi gher than open and left laparoscopic donor nephrectomy on postoperative day 1, but at all remaining intervals the right laparoscopic donors had equiva lent creatinine values. Conclusions These results confirm that right laparoscopic donor nephrectomy provides similar patient benefits, including early return to diet and disc harge. Long-term creatinine values were no higher than in traditional open donor or left laparoscopic donor cohorts. These results establish that earl y concerns about high thrombosis rates are not supported by a multilnstitut ional review of laparoscopic right donor nephrectomies.